Abstract：
:In this study, we sought to identify changes in the picture of a selected surgical condition during an interval of time that has brought about radical departures from previously established policies and programs. As a direct consequence, the patients take a more circuitous route to the surgeon. A significant number of patients with acute appendicitis in 1986 (37 percent) and 1987 (29 percent) suffered a prolonged delay in hospitalization or surgical referral compared with patients in 1980. This delay was accompanied by a more advanced stage of disease that ultimately caused a markedly increased morbidity (13 percent in 1986 and 24 percent in 1987, compared with 5 percent in 1980) and subsequent extended length of stay. This deterioration in patient care and failure at cost containment had previously been examined for conditions that can be operated electively. This study documents that the constraints also affect the treatment of patients whose initial condition requires urgent operative treatment. With specific relation to patients with acute appendicitis, surgeons recognize the value of the negative appendectomy. It appears the so-called gatekeepers must find a way to accept a certain negative hospitalization to referral rate. If current constraints will not allow this, the policies and programs behind the constraints should be changed.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Cacioppo JC,Diettrich NA,Kaplan G,Nora PFdoi
10.1016/0002-9610(89)90549-7subject
Has Abstractpub_date
1989-03-01 00:00:00pages
276-81issue
3eissn
0002-9610issn
1879-1883pii
0002-9610(89)90549-7journal_volume
157pub_type
杂志文章abstract：:Recent advances in molecular biology have greatly accelerated knowledge relating to the significance of the enterohepatic circulation of bile salts. This review highlights the role that both oxysterols and bile salts play as ligands which, when bound to nuclear hormone receptors, activate transcription factors that se...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/s0002-9610(02)01212-6
更新日期：2003-02-01 00:00:00
abstract：BACKGROUND:The optimal surgery for patients with renal hyperparathyroidism has been controversial, as either subtotal parathyroidectomy (subtotal PTX) or total parathyroidectomy with auto-transplantation (total PTX-AT) may be employed. METHODS:Adult patients having subtotal PTX or total PTX-AT for secondary hyperparat...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2017.07.018
更新日期：2017-11-01 00:00:00
abstract：BACKGROUND:Pancreatic neoplasms can be difficult to diagnose and stage preoperatively. Accurate staging allows the surgeon to select which patients can benefit from resection versus palliative therapy. Endoscopic ultrasound (EUS) with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a diagnostic modalit...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(97)80928-2
更新日期：1997-12-01 00:00:00
abstract：BACKGROUND:Work-related injuries (WRIs) represent a significant economic and logistical burden to healthcare systems. METHODS:All patients with severe WRIs (Injury Severity Score [ISS] ≥ 12) (1995 to 2013) were compared with patients with non-WRIs using standard methodology (P < .05). RESULTS:A total of 1,270 (8.5%) ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2015.01.023
更新日期：2015-09-01 00:00:00
abstract：:The portal-superior mesenteric vein (PV/SMV) is occasionally involved by a microscopic level of cancer invasion from pancreatic cancer even when it seems to be intact by a macroscopic inspection during surgery. Therefore, contact endoscopy, with which a high-magnification image of the methylene blue-stained PV/SMV wal...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2009.03.009
更新日期：2009-11-01 00:00:00
abstract：BACKGROUND:After enthusiasm for total pancreatectomy for pancreatic adenocarcinoma peaked in the 1970s, a failure to improve outcomes in the 1980s led to fewer reports of this procedure. METHODS:We retrieved records from 252 Whipple and 47 total pancreatectomies for pancreatic cancer performed at U.S. Department of Ve...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80126-6
更新日期：1994-12-01 00:00:00
abstract：BACKGROUND:Cognitive skills such as decision-making are critical to developing operative autonomy. We explored resident decision-making using a recollection of specific examples, from the attending surgeon and resident, after laparoscopic cholecystectomy. METHODS:In a separate semi-structured interview, the attending ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2017.06.006
更新日期：2017-10-01 00:00:00
abstract：BACKGROUND:Hepatic resection is main approach to treatment of hepatolithiasis, but the long-term follow-up results of hepatic resection for hepatolithiasis are rarely reported. METHODS:A retrospective study was conducted of 87 patients with hepatolithiasis who underwent hepatic resection. RESULTS:The final stone clea...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2008.08.020
更新日期：2009-08-01 00:00:00
abstract：:Though morbidity and mortality rates following pancreatic resection have improved in recent years, they are still around 35% and 5%, respectively. Typical complications, such as pancreatic fistula, abscess, and subsequent sepsis, are chiefly associated with exocrine pancreatic secretion. In order to clarify whether th...
journal_title：American journal of surgery
pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
doi：10.1016/0002-9610(92)90264-r
更新日期：1992-01-01 00:00:00
abstract：BACKGROUND:Trauma in pregnancy remains an important but understudied public health issue. We aimed to determine the prevalence of interpersonal violence in our pregnant trauma population (including pediatric) over the last 20 years, from our Level I trauma center. METHODS:We conducted a descriptive, retrospective char...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2017.07.003
更新日期：2017-10-01 00:00:00
abstract：BACKGROUND:The aim of this analysis is to compare the postoperative outcomes of resection and enucleation of small pancreatic neuroendocrine tumors (PNETs). METHODS:The 2014-17 American College of Surgeons-NSQIP dataset was queried. Patients undergoing pancreatoduodenectomy (N = 297) or distal pancreatectomy (N = 712)...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.12.013
更新日期：2020-12-08 00:00:00
abstract：:Breast symptoms of pain, tenderness, and engorgement correlate with objective findings of nodularity on physical examination. Like all other factors for breast disease, they are not a single determinant of diagnosis, as shown by the 3 X 3 contingency table, but they are a useful addition to our understanding. From the...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(85)90135-7
更新日期：1985-08-01 00:00:00
abstract：BACKGROUND:Many women with breast cancer recurrence previously treated with breast-conservation therapy desire repeat lumpectomies. We hypothesized that women undergoing mastectomy for breast cancer recurrence would show superior survival. METHODS:Patients who previously received breast-conservation therapy diagnosed ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2008.06.018
更新日期：2008-10-01 00:00:00
abstract：BACKGROUND:Trauma readmissions have been well studied but little data exists regarding Emergency Department (ED) utilization following an injury. This study was performed to determine the factors associated with a return to the ED after trauma. METHODS:A retrospective review of all adult trauma patients evaluated betw...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2019.10.046
更新日期：2020-07-01 00:00:00
abstract：BACKGROUND:Perianal fistula disease (PAD) occurs in up to 40% of patients with Crohn's disease (CD). Medical therapy is often unsuccessful, and, with surgical therapy, healing is unreliable and management is frequently painful and unsatisfactory. Outpatient CO(2) laser ablation of PAD has emerged as an alternative. ME...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2005.10.050
更新日期：2006-03-01 00:00:00
abstract：BACKGROUND:Port placement injuries are a potentially devastating complication of laparoscopic surgery. Ultrasound assessment for visceral slide has the ability to preoperatively determine adhesion-free areas. The utility of this technique has not been studied when performed by surgeons. METHODS:Surgeons without expert...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2014.12.020
更新日期：2015-05-01 00:00:00
abstract：BACKGROUND:The Michigan Appropriate Perioperative (MAP) criteria provide guidance regarding urinary catheter use. For Category A (e.g., laparoscopic cholecystectomy), B (e.g., hemicolectomy), and C (e.g., abdominoperineal resection) procedures, recommendations are to avoid catheter, remove POD 0 or 1, and remove POD 1-...
journal_title：American journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.amjsurg.2020.01.008
更新日期：2020-09-01 00:00:00
abstract：BACKGROUND:It is widely accepted that mastectomy and breast-conserving surgery (BCS) with irradiation yield similar results, yet many women continue to receive mastectomy. This study evaluates factors contributing to surgical decision-making in breast cancer. Registry data were obtained on all patients treated at the S...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2009.05.031
更新日期：2009-12-01 00:00:00
abstract：:Three patients who underwent 95 percent removal of the pancreas for chronic pancreatitis with autotransplantation of the body and tail of the gland to the femoral area are described. The follow-up periods are 18, 6, and 2 months. Pain lessened in all patients and none required exogenous insulin. Patency of the graft w...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(83)90036-3
更新日期：1983-04-01 00:00:00
abstract：BACKGROUND:Patient factors impact laparoscopic cholecystectomy (LC) difficulty, specifically operative duration. This study quantifies the impact of patient factors on LC duration. METHODS:The national surgery database (American College of Surgeons National Surgical Quality Improvement Program) was reviewed for all el...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2016.01.024
更新日期：2016-08-01 00:00:00
abstract：:The management of the failing myocardium was primarily empirical for centuries, until Withering introduced foxglove (digitalis) in 1785 as an effective medication. Gradually, the medical treatment included, besides digitalis preparations, the use of diuretics to reduce excessive sodium and water retention; limiting sa...
journal_title：American journal of surgery
pub_type： 历史文章,杂志文章
doi：10.1016/0002-9610(84)90186-7
更新日期：1984-06-01 00:00:00
abstract：:Abdominal muscular contractions may have a protective influence against the development of indirect inguinal hernia. A portion of the transversus abdominus muscles acts on the internal inguinal rings and produces a closure mechanism during voluntary abdominal muscular activity. It follows, therefore, that injury or in...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(82)90108-8
更新日期：1982-03-01 00:00:00
abstract：:The dose response curves for acid and pepsin output to increasing intravenous doses of pentagastrin (0.01, 0.02, 2, 8, and 16 micrograms/kg per hour) were determined in six male patients with duodenal ulcer and six with type 1 corporeal gastric ulcer before and 3 to 6 months after selective proximal vagotomy and excis...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(85)90433-7
更新日期：1985-11-01 00:00:00
abstract：:Splenectomy was performed in 20 patients with refractory cytopenias associated with systemic lupus erythematosus. An immediate and sustained increase in platelet count (greater than 150,000 cells/mm3) was achieved in 12 of 18 patients whose principal indication for operation was thrombocytopenia. Of seven patients wit...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(88)80097-7
更新日期：1988-03-01 00:00:00
abstract：:A simple classification of inguinal hernias is presented which can be valuable to surgeons as a (1) blueprint for dissecting the canal, (2) means for choosing the most appropriate operative procedure, (3) means for evaluating and correlating the prognosis of postoperative symptoms, time of convalescence, and degree of...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(89)90564-3
更新日期：1989-03-01 00:00:00
abstract：OBJECTIVE:Invasive lobular carcinoma (ILC) presents special challenges to treating physicians because of the diffuse infiltrative growth pattern. As sentinel lymph node dissection (SLND) is rapidly replacing axillary lymph node dissection (ALND) in the management of patients with early-stage breast cancer, we sought to...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2005.06.021
更新日期：2005-10-01 00:00:00
abstract：BACKGROUND:Silicone venous access devices (VADs) are commonly used for multiple intravenous infusions and blood sampling in chronically ill patients, particularly cancer patients. These devices are susceptible to malfunctions most commonly characterized by difficulty infusing fluids or withdrawing blood. We hypothesize...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(99)00124-5
更新日期：1999-07-01 00:00:00
abstract：BACKGROUND:Using an original model, the Donor Rat Model, we showed that bile-pancreatic juice (BPJ) exclusion from gut exacerbates ligation-induced acute pancreatitis in rats. We also showed that muscarinic cholinergic M3 and CCK-A receptor expression is induced following duct ligation. Increased receptor number potent...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2004.07.008
更新日期：2004-11-01 00:00:00
abstract：:Forty-one patients with significant pulmonary emboli were reviewed. The presence of heart disease and obesity was found with relatively constant frequency throughout the groups presented. Postoperative infections (wounds or abscess) were frequently associated with fatal or significant pulmonary embolism, particularly ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90067-9
更新日期：1979-03-01 00:00:00
abstract：:We believe that paragangliomas of the carotid body should be excised in all patients unless formidable medical conditions prohibit the use of general anesthesia. If these tumors are left unresected, they will eventually grow to invade the skull and kill the patient. With definitive diagnostic modalities available, in ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(83)90052-1
更新日期：1983-04-01 00:00:00
